After another two-year cycle of dedicated service, the African constituencies are renewing their representatives in accordance with the governance manual. The African constituencies has registered quite a handful of triumphs on many fronts in the last two years. Ensuring that Resilient and Sustainable Systems for Health (RSSH) becomes one of the Global Fund’s strategy between 2017-2022 has been one major success, thanks to concerted efforts by the African constituencies and its leadership. The operationalization and staffing of the African Constituencies Bureau (ACB) that is making great strides in ensuring the African constituency representatives have at their hands well-researched and informed policy analysis and recommendations is yet another critical legacy of the 2016-2018 leadership.
Other successes under the oversight of the out-going leadership include successful hosting of Annual Consultative Meetings (ACB), introduction of Cluster Based Learning Networks (CBLNs) to maximize bottom-up approaches and increase countries’ engagement and deliberations over Global Fund policies and decisions, strengthening partnerships with the African Union (AU), donors, technical partners, etc., to mentioned but a few. As we turn on the leaf to another set of leaders, its critical to take stock of what we have achieved over the last two years and what we can focus on in the next two years. This paper seeks to identify the successes and triumphs, disappointments and legacies of the out-going leadership and the vision, hopes and aspirations of the in-coming leadership, in their own words.
In doing so, the Bureau wishes to thank the out-going leadership for their commitment, dedication and fearlessness in providing oversight to the African constituencies and in striving for a strengthened African voice in Global Fund policies and decisions. Well done! We also wish to welcome the new leadership and wish them a successful tenure during which the African constituencies will build on the successes of the out-going leadership and make the African constituencies even stronger and greater.
Dr. David Kihumuro Apuuli, Board Member, Eastern and Southern Africa (ESA), 2016-2018, He is medical doctor with more than forty (40) years of experience in health planning and management, Dr. Apuuli has served as General Director of the Uganda AIDS Commission and of the Ministry of Health in Uganda. He also served on the Uganda Country Coordinating Mechanism. Dr. Apuuli looks nostalgic about his mandate.
What were your greatest achievements during your tenure as Africa representative to the GF Board? The two years of my tenure, first as the Alternate Board Member and later as a full Board Member for ESA, have revealed how the combined voice of Africa can have critical impact on Global Fund decisions. The combined voice of ESA and WCA made it possible for the Global Fund to accept to have RSSH as one of the main objectives and focus areas of the Fund’s Strategic Plan 2017-2022. We were also able to ensure that Catalytic Funding is included in country allocations with effect from 2018 funding cycle. As African Constituencies, we have been actively engaged within the ImG in our capacity as implementers and the Continent that has the highest disease burden. During my tenure, I proudly celebrate the fact that the African Constituencies Bureau (ACB) was fully operationalized, staffed and resourced. Lastly, another key achievement that I am proud of is that the African Voice is now recognized, valued and respected within the Global Fund processes.
What could you have done differently? It is worth noting that the Implementer Group (ImG) is composed of 10 Constituencies that include ESA and WCA. The challenge for ESA and WCA Board Members is often around harmonizing positions within ImG. Sometimes the views and positions of ImG differ significantly from the African Positions partly due to the fact that ImG is predominantly comprised of Civil Society / NGOs and People Living with the 3 Diseases. Therefore, as a Board Member, trying to harmonize your positions as an Implementer while at the same time balancing the interests of the African Constituency is a never-ending task. We therefore have to find a way to harmonize this so as to avoid the parallels and tensions.
What were your best moments as a Board Member? The best moments of my tenure is when the two African Constituencies elected me to be the Chair of the Board of the ACB Board.
Your disappointment? My disappointment is that my term especially as full Board Member for ESA was short – roughly 1 year – yet I am supposed to serve for 2 full years. The ACB Governance Framework should critically look at this issue so that once one is elected, they serve their 2 full years. If you were given another opportunity to represent Africa on the GF Board, what would you do differently? If given another chance to serve on the Board, I would like to see African Governments recognize the importance of ACB and fund its operations.
What do you think you will be remembered for? I hope the countries of Africa will remember me for the commitment, perseverance, fearlessness and brevity that I have exhibited. This has enabled for the breaking of many barriers, voicing and speaking out to ably represent my people’s interest and ensuring that African voices are part and parcel of decision-making at all levels and at the core of GF Board mechanism and processes.
Major General (Dr.) Gerald Gwinji, Outgoing and Incoming Alternate Board Member ESA, 2016-2018, He is the permanent secretary of Zimbabwe’s Ministry of Health and Child Care. Dr Gwinji is a medical doctor by profession, specializing in public health. He has a passion for and long career in public health management. He served as a brigadier general presiding over military health services in Zimbabwe. He counts on his previous experience as alternate to adjust and push more the Africa voice. According to him being well informed is critical for unified and powerful voice.
What inspired you to make yourself available to represent Africa on the GF Board? The Sub-Saharan African bears the biggest burden of HIV and AIDS. This happens in an environment where most countries are struggling to raise enough resources to respond to the burden of the three diseases. The Global Fund is the biggest funding partner for the three diseases. As a government official it is my responsibility to ensure that partner funds are utilized transparently while ensuring maximum impact for the resources. As a key government decision maker, I felt my contribution as a board member will demonstrate a high level of government commitment to GF processes.
What would you want to achieve in the next 2 years of your tenure? At the end of my tenure as an Alternate Board Member I hope that there will be an appreciation of the current challenges that developing countries face in terms of health delivery systems. These factors should be taken into consideration in the next funding cycle. I also hope to motivate member states so that they increase their support for the general health delivery systems including community system strengthening.
What opportunities do you see ahead of you? The Regional blocks (clusters) meetings present a good opportunity for Member States to have an appreciation of GF processes and updates. GF board meetings also offer an opportunity for dialogue between funding partners and beneficiaries.
What is your vision of a stronger African Constituencies? My vision for a stronger African Constituency is a well-informed unified voice. A constituency that demonstrates a commitment to take care of the health needs of its citizens.
Dr. Oly ilunga kalenga, Board Member for WCA, 2018-2020As new comer, MD, PhD in Public Health and Health economics specialist, Dr. Oly ILUNGA KALENGA worked for more than thirty years at European Hospitals in Brussels. He started as an assistant before becoming a specialist in internal medicine, head of the intensive care unit and, finally Medical Director and Managing Director/CEO from January 2013 to December 2016. He has been educated in Belgium where he undertook his medical studies, his PhD in Public Health and Epidemiology, and his MBA, with a specialization in Health economics. He is the current Minister of Health of DRC. He arrived on the Board as he joined the DRC Government, with the ambition to contribute to the improvement of living conditions of the Congolese population by restoring the credibility of the public health sector.
What inspired you to make yourself available to represent Africa on the GF Board? As DRC’s Minister of Health, I experience first-hand how Malaria, HIV/AIDS and Tuberculosis have taken a toll on the African population in terms of loss of economic and human development opportunities. This also means that I witness everyday the positive impact the Global Fund has had in fighting these three epidemics. For instance, together with Nigeria, DRC accounts for more than 35 % of global malaria deaths. However, thanks to the commitment of the Congolese Government and the Global Fund investments, the reported number of malaria cases and deaths has been steadily decreasing and about 90% of Congolese households have now access to free mosquito nets. This truly inspired me to join the Global Fund Board and, henceforth, contributing to write a new page in the world’s fight against malaria, HIV/AIDS and tuberculosis.
What would you want to achieve in the next two years of your tenure? The Global Fund has completely changed the world’s approach towards fighting malaria, HIV/AIDS and tuberculosis. However, its strategy could be further improved to ensure its investment has an even greater impact on the communities it wants to serve. More particularly, moving from a resource-based to a result-based approach and a greater collaboration between donors would ensure a higher return on investment for each dollar the Global Fund invests. Furthermore, the Global Fund should engage more with private actors who have become some of the greatest partners of the African public sector to offer health services. Last but not least, as health is multi-dimensional, the Global Fund would benefit from a more integrated and multi-sectoral approach. This will help us achieve better results and contribute to the sustainability of the Global Fund’s investments. I know these are ambitious goals to try to achieve in only 2 years. But even sowing the seeds of change at the Global Fund would be a significant achievement.
What opportunities do you see ahead of you? Although malaria, HIV/AIDS and tuberculosis remain major global health issues, there has been considerable progress and effort towards their elimination over the past few years. There is now a global consensus that with targeted, effective actions we can achieve a world free from these three terrible diseases. This is a fantastic momentum that can be used to further accelerate the work of the Global Fund. There are numerous other opportunities for change and improvement based on the wide range of country experiences. Since its creation in 2002, the Global Fund has invested in more than 150 countries across Asia, Latin America and Africa. These are more than 150 learning experiences about the best way to fight these three deadly diseases. We can, therefore, build on successes in some countries and learn from past failures. Combined with a result-oriented approach and a search for efficiency, this diversity of experiences can be a source of innovation to develop original and unique solutions adapted to the local context of each country.
What do you see as the main challenges ahead? Despite the important progress in recent years, HIV/AIDS, tuberculosis and malaria remain major global health issues as demonstrated by world statistics. Globally, an estimated 36.7 million people are living with HIV, tuberculosis remains one of the top 10 causes of death worldwide with over 1.7 million deaths in 2016, and 216 million cases of malaria were reported that same year. While the medical treatment and care of patients suffering from these diseases has greatly improved, the best prevention remains a healthy and responsible behaviour. However, behaviour change among affected populations is the hardest part of our work. When we talk about access barriers to health services in developing countries, we often focus on financial and geographic barriers. We tend to ignore or overlook cultural barriers, such as religious or traditional beliefs, which shape people’s behaviour and influence their decision to look for appropriate health solutions. We will have to invest more in behaviour change strategies if we want to ensure the sustainability of the impact of the Global Fund.
What is your vision of a stronger African Constituencies? Health is a common good that knows no boundaries. Similarly, diseases affect all our communities without making any distinction based on nationality. Therefore, continental and international cooperation is essential to ensure the world’s safety. At the global level, this is the primary objective of the Global Health Security Agenda. At the African level, there is room for improvement by strengthening our cooperation and communication. By working closely together, African Constituencies can raise the African voice and reinforce the African position in the Global Fund Board. One way to achieve this goal is by strengthening the communications with the different African countries through their Country Coordinating Mechanisms. Achieving stronger African Constituencies also requires full responsibility and accountability on the part of African Governments. Governments are ultimately the ones responsible to protect the health and safety of their populations. Therefore, increasing domestic resource mobilization to invest in health programmes should be a priority. By contributing more to the Global Fund activities, their voice will have more weight in the discussions about the Fund investments. Furthermore, active and strong African Constituencies can also serve as a bridge between the Global Fund and the African Governments it seeks to support. The Global Fund is still not well known or understood by Governments and there is much misunderstanding around different issues like counterpart financing. We can solve these misunderstandings by first consulting all the member states of both African Constituencies in order to ensure that their concerns and objectives are well represented at the Board level. Then, African Board members should be accountable and have a responsibility to report back in details what has been decided. This will ensure that no country feels left out of the discussions and key decisions of the Global Fund.
Dr. Kebede Worku, Board Member for ESA, 2018-2020
What inspired you to make yourself available to represent Africa on the GF Board? I am inspired by excellent work done by the Global Fund around the world. Since its establishment in 2002, GF has averted millions of deaths due to HIV, tuberculosis, malaria and other diseases. I believe that, without the support of GF to countries and communities most in need, the implementation of Millennium Development Goals (MDGs) would have been a different history. With principal support of GF, for instance, Ethiopia met all MDG targets related to HIV, tuberculous and malaria. In Ethiopia, new HIV infections plummeted by more than 90% in less than a decade; and mortalities related to malaria and tuberculosis declined by more than 50% between 1990 and 2015.
What would you want to achieve in the next 2 years of your tenure? As global goals have transitioned from MDGs to Sustainable Development Goals (SDGs), I will focus on putting the African Constituencies on the right trajectory to end HIV, tuberculosis and malaria as public health threats by 2030. This entails strengthening health and community systems and developing flexible and innovative programs specific to HIV, tuberculosis and malaria in the African Constituencies. This also requires systematic engagement with local governments and communities and smart partnership with international donors and private philanthropies. Additionally, I will focus on effective, efficient and transparent use of grants and I will push for sizable proportion of domestic financing to drive impact in the African Constituencies.
What opportunities do you see ahead of you? Ample opportunities exist to move the GF agenda forward. Collectively, the global health community have solidly committed to the bold health SDGs and Universal Health Coverage (UHC) through primary health care. I hope the accelerated economic growth and political commitment in each country in the Constituencies will translate into meaningful actions on HIV, tuberculosis and malaria.
What do you see as the main challenges ahead? I see outbreaks and epidemics as major challenge to programs including HIV, tuberculosis and malaria. They compete with the programs for resources and they have added burden to the health and community systems. Further, the current declining trend in funding for these priority diseases may create a chasm in implementation, and ultimately impacts results.
What is your vision of a stronger African Constituencies? My vision is to create complete country ownership of the programs and, ultimately to see post HIV, tuberculosis and malaria African Constituencies. The last two years have undoubtedly seen the African constituencies’ voice in Global Fund policies and decisions. Looking forward to the next two years, during which time the world seeks to attain HIV infection control, ensure WCA catches up on the HIV front, move towards halving the malaria epidemic by 2023, we inaugurate a new leadership that will yet strengthen the African voice in Global Fund policies and decisions. Put together, their visions around various issues resonate and should put Africa, in the words of one of the new leaders, “on the right trajectory to end AIDS, tuberculosis and malaria”. Their individual aspirations speak of: “a well-informed and unified African voice”, “CBLNs as a major building block in African countries’ engagement in Global Fund policies and decisions”, “actualize the vision of stronger health systems…including community systems”, “continental and international cooperation”, “strengthened cooperation and coordination among African states”, “enshrining/imbedding responsibility and accountability in African Governments”, “strengthening domestic resource mobilization”, “building ACB as a bridge between African Governments and the Global Fund which entails ensuring consultations with African Governments to ensure their concerns and objectives are transmitted/represented”, “African ownership of the responses and impact against the three epidemics”, “developing innovative programs”, “strategic investment with local governments, communities and smart partnerships with donors, private sector and philanthropists”, “African Governments recognize the importance of ACB and fund its operations” and lastly “effective, efficient and transparent grants”. When these ideas are well reflected on and aligned to each other towards one goal, African countries will not just increase its voice in Global Fund policies and decisions, and in Global Health discourses at large, but, together with donors, technical partners, private sector and philanthropists, academia, and civil society, will be able to see the back of the three epidemics in 2030. To do so, we need to be fully aware of the challenges that lie ahead of us: Africa remains the continent with the largest burden of the three epidemics, Global Health resources have plateaued in the face of financial scarcity, African Governments’ failure to meet Abuja commitments, poor health service delivery systems. Yet, together, we can meet head on the challenges of our era and turn around the trends. Will and commitment, willingness to learn, change and adapt, and a commitment to innovativeness, integrity, transparency, accountability, effectiveness and parsimony. Africa Constituencies renewed its governance three times:
Eastern and Southern Africa
Western and Central Africa
Board Member: Dr. Anita Asiimwe
Board Member: Prof. Christian Otu Onyebuchi Chukwu
Alternate Board Member: Xaba Benedict
Alternate Board Member: Mireille PrinceDavid
Communications Focal Point: Mrs. Ida Hakizinka
Communications Focal Point: Dr. Fatai Wole Bello
Eastern and Southern Africa
Western and Central Africa
Board Member: Dr. David Apuuli
Board Member: Prof. Awa Marie Coll Seck
Alternate Board Member: Major General Dr. Gerald Gwinji
Alternate Board Member: Dr. Bernice Dahn
Communications Focal Point: Ms Syson Namaganda Laing
Communications Focal Point: Dr. Abdoulaye Anne
Eastern and Southern Africa
Western and Central Africa
Board Member: H.E. Dr. Kebede Worku Admassu
Board Member: Dr. Oly Ilunga Kalenga
Alternate Board Member: Major General Dr. Gerald Gwinji